MBT

Part III

Dr. Amol Pharande

Overbite Control
Development of Deep Overbite
Ant teeth continue to erupt until contact is
made with opposing ant teeth

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Overbite Control
Development of Deep Overbite
Unrestricted eruption of low 2nd molars in cl II

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Overbite Control
The tooth movements of bite opening -

Eruption/extrusion of post teeth

Distal tipping of post teeth
Proclination of incisors
Intrusion of incisors
A combination of two or more of the above

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Overbite Control
Eruption/extrusion of post teeth
Growing pts
 Adults – low angle
 Adults – high angle

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Overbite Control
Distal tipping of post teeth

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Overbite Control
Proclination of incisors
Deep bite with retroclined incisors

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Overbite Control
Intrusion of anterior teeth
Growing pts – preventing normal eruption
Adults – intrusion arches

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Overbite Control
Non-Extraction t/t
Generally favors bite opening

Mechanical factors contributing to bite

opening
Initial archwire placement
The bite-plate effect

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 Overbite Control
The bite-plate effect
Allows for early placement of
low incisor brackets
Intrusive force on low incisors
Allow for extrusion/uprighting
of post teeth

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Overbite Control
Creating the bite-plate effect
Acrylic ant bite plates
Low angle deep bite cases

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Overbite Control
Creating the bite-plate effect
Direct bonding material on palatal surface of
upp incisors
High angle – occl surfaces of molars

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Overbite Control
The importance of second molars
Low-angle deep bite cases – earliest banding
of 2nd molars

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Overbite Control
The importance of second molars

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Overbite Control
The importance of second molars
Leveling of curve of Spee

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Overbite Control
Bite – opening curves

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Overbite Control
Bite – opening curves
Lower – 10 -15 of labial root torque
0 0

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Overbite Control
Elastics

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Overbite Control
Anterior open bites
Genetic
Environmental

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Overbite Control
Early management of open bites
Discontinue habit
Palatal expansion
Palatal bars
Post bite plates
High pull HG

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Space Closure
Maximum, Minimum, Moderate anchorage

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Space Closure

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Methods of Space Closure
Closing loop archwires
Sliding mechanics with heavy forces
Elastic chain
Sliding mechanics with light continuous
forces

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Methods of Space Closure
Closing loop archwires

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Methods of Space Closure
Sliding mechanics with heavy forces
Traditional edgewise force levels (500-600 gm)
Torque loss

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Methods of Space Closure
Sliding mechanics with heavy forces
Traditional edgewise force levels (500-600 gm)
Torque loss
Rotations

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Methods of Space Closure
Sliding mechanics with heavy forces
Traditional edgewise force levels (500-600 gm)
Torque loss
Rotations
Tipping

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Methods of Space Closure
Extra tip, torque & rotational control
Heavier demand on anchorage
Over-corrected tooth positions at the end

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Methods of Space Closure
Elastic chain
350-400gm
Used for minor spaces towards end of t/t,
maintenance

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Methods of Space Closure
Sliding Mechanics with Light Forces
Archwires - .019/.025 steel

Soldered hooks
0.7 soldered brass hooks, 0.6SS

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Methods of Space Closure –
Sliding Mechanics with Light Forces
Passive tiebacks

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Sliding Mechanics with Light
Forces
Active tiebacks using elastomeric modules
Simple, economical & reliable
Stretched twice its normal size

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Sliding Mechanics with Light
Forces
Active tiebacks using elastomeric modules
Force levels
Type of module, pre-stretching, amt of
stretching
50-100 gm if pre-stretched, or worked
200-300 if used directly

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Sliding Mechanics with Light
Forces
Type one active tieback (distal module)

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Sliding Mechanics with Light
Forces
Type two active tieback (mesial module)

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Sliding Mechanics with Light
Forces
Active tiebacks using Ni-Ti coil springs
Large spaces
Infrequent adjustment opportunities

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 Sliding Mechanics with Light
Forces
Efficiency of elastic
module tiebacks
compared to Ni-Ti coil
springs

Samuel et al – 17
subjects, medium grade
(yellow) Sentalloy™ by
GAC

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Sliding Mechanics with Light
Forces
Rapid & consistent space closure with Ni-Ti
coil springs
Optimum force – 150 gm
22mm for 9mm, and 36mm for 12mm springs

Authors prefer to use elastomeric modules

Rapid space closure – incisor torque ‘lost’
Simple, economical, work well

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Obstacles to Space Closure
Measure the spaces at successive visits

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Obstacles to Space Closure
Inadequate leveling

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Obstacles to Space Closure
Damaged brackets

Incorrect force levels

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 Obstacles to Space Closure

Interference from
opposing teeth

Soft tissue
resistance

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Alternative Mechanics for Spaces
Resistant to Closure
Tiebacks with two modules
Looped archwire
Hycon® device from Edenta
.021/.025 steel wire, soldered 7mm screw device
Ligature wire engaged – 2 turns per week (1/8mm)
Short acting but strong force that essentially
overcomes any frictional concerns

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Finishing The Case
Condyles in seated position – in centric
relation
Relaxed healthy musculature
A “six keys” class I occlusion
Ideal functional movements – a mutually
protected occlusion
Periodontal health
Best possible aesthetics

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Finishing & Detailing
Std edgewise – significant amt of wire
bending during finishing stage

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Finishing & Detailing
Preadjusted edgewise –
‘ Finishing & detailing is no longer a separate and
lengthy stage of mechanics, but more a rewarding
outcome for good management of the case, earlier in
the treatment’

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Finishing & Detailing
Defn : The correction of errors made prior to
finishing & detailing, over-correction as needed,
and settling of the case.
Variations in the shape & size of the pt’s teeth
relative to the avg measurements built into the
preadjusted appliance
Inaccuracies or shortcomings in the appliance design
Use of force levels that ‘overpower’ the appliance
design
Inaccuracies in appliance placement
Failure to allow sufficient time for the bracket system
to express itself
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Final Stage of Finishing –
Settling The Case
Lower - .014” or .016” NiTi or .014” steel
Upper - .014” SS sectional
4-6 weeks

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 Settling The Case

Variations
Cuspids
Diastema
Extraction – fig 8
ligatures
Palatal expansion
Mod to severe Class II/1

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Appliance Removal
All-at-one-visit appliance removal

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Appliance Removal
All-at-one-visit appliance removal

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Retention

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Post – Treatment Consultation
Review initial problem & final results

Refreshing their memories leads to

happier patients and more referrals!

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Summary
The only fully documented PEA ‘system’
Tip & torque changes

0 0 0 0 8 8 4

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Summary
Tip & torque changes

-14 -14 -7 -7 -7/0 10 17

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Summary
Tip & torque changes
0 0 2 2 3 0 0

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Summary
Tip & torque changes

-10 -20 -17 -12 -6/0 -6 -6

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Summary
Versatility
Bracket positioning
Anchorage control
Lacebacks, Bendbacks, Tiebacks
Force levels –
Light – continuous forces
Sliding mechanics
150gm
Finishing & detailing

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“ There is no such thing as an isolated
orthodontic act. More effort and knowledge is
required to prevent or control unwanted tooth
movements than to apply the primary forces.”

- Thurow

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